Risk assessment and perioperative care in perihilar cholangiocarcinoma

Perihilar cholangiocarcinoma is one of the most complex gastrointestinal malignancies due to the many pitfalls encountered at various stages of its management. Despite several techniques to optimize the patient for operation, liver surgery for perihilar cholangiocarcinoma remains a hazardous procedure and may not be justified in all patients. The aim of this thesis was to provide recommendations for the staging, risk assessment and perioperative care in order to improve patient selection and surgical safety. The first part of the thesis focuses on biliary drainage to relieve jaundice before surgery, with special attention to the use of either endoscopic or percutaneous drains. In the second part, the limitations and potential improvements of preoperative staging are discussed. The third part of this work deals with the preoperative assessment of the risks associated with surgical resection.